# FAMILY MEDICINE & WEIGHT MANAGEMENT SPECIALTY, P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962736348
- **Authorized official:** KIRSTEN A SORENSEN (ADMINISTRATOR)
- **Authorized official phone:** (602) 431-1152

## Contact information

- **Practice address:** 2222 S AVENUE A, YUMA, AZ 85364-8315
- **Practice address phone:** (928) 276-4381
- **Mailing address:** 2189 S. AVENUE A, SUITE A, YUMA, AZ 85364-8880
- **Mailing address phone:** (928) 276-4381
- **Mailing address fax:** (928) 276-9086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4158 | AZ | Yes |

## Other

- **Enumeration date:** 10/01/2009
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | Z178594 | MEDICARE PTAN FOR STATEOF ARIZONA | AZ |